Provider Demographics
NPI:1437328762
Name:PRICE, AMY M (MFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1740 LA COSTA MEADOWS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5199
Mailing Address - Country:US
Mailing Address - Phone:760-593-7350
Mailing Address - Fax:760-591-0086
Practice Address - Street 1:1740 LA COSTA MEADOWS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5199
Practice Address - Country:US
Practice Address - Phone:760-593-7350
Practice Address - Fax:760-591-0086
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 44255106H00000X
CAMFC48856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist